Background: The minimal right vertical infra-axillary thoracotomy approach is one type of incision procedure for congenital heart operations. Objectives: This report describes our experience with this exposure in a limited group of patients under one year of age. Methods: We retrospectively reviewed 44 patients that underwent correction of a congenital heart defect utilizing a standard median sternotomy or a minimal right vertical infra-axillary thoracotomy over one year period. Group 1 consisted of 12 patients that underwent the minimal right vertical infra-axillary thoracotomy while group 2 was made up of 32 patient's underling a standard median sternotomy. Variable utilized in this comparison included; length of incision, total operative time, cardiopulmonary bypass and cross clamp time, total chest tube output, length of ICU and hospital stay, and duration of mechanical ventilator support. Results: During follow-up period, no deaths were observed in both groups. Both groups had no reoperation for bleeding or residual shunt and had no morbidity. Group 1 patients' families were very satisfied. Group 1 had a statistically longer bypass time, then Group 2 (P = 0.031). Group 1 had less chest tube drainage (P = 0.069), shorter ventilator times (P = 0.03) and shorter ICU (P = 0.022) and hospital stays (P = 0.03) then compared to Group 2. Conclusions: The intracardiac repair of certain congenital heart defects in children under one year of age can be performed safely and effectively using the right vertical infra-axillary minithoracotomy approach.